Healthcare Provider Details

I. General information

NPI: 1649887043
Provider Name (Legal Business Name): HORIZONS UNLIMITED,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 E BROADWAY RD
MESA AZ
85210-1625
US

IV. Provider business mailing address

PO BOX 930
MESA AZ
85211-0930
US

V. Phone/Fax

Practice location:
  • Phone: 480-358-8956
  • Fax:
Mailing address:
  • Phone: 480-907-8900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MS. EILEEN RATLIFFE
Title or Position: CEO
Credential:
Phone: 480-907-8900